The League joined a letter to the U.S. Senate urging them to reject H.R. 1628, the American Health Care Act. The Senate is considering legislation to move forward that includes provisions from legislation in the U.S. House that would repeal the Affordable Care Act (ACA); slash federal funding and transform Medicaid into a block grant or per capita cap; eliminate the Medicaid expansion, and defund Planned Parenthood health centers.

On behalf of The Leadership Conference on Civil and Human Rights, the National Health Law Program, the National Partnership for Women & Families, and the undersigned 163 organizations, we urge you to oppose any attempt to repeal the Affordable Care Act (ACA); slash federal funding and transform Medicaid into a block grant or per capita cap; eliminate the Medicaid expansion; and defund Planned Parenthood health centers.

Repealing the ACA, and restructuring and reducing the financing and coverage of Medicaid as proposed by the American Health Care Act (AHCA), would leave at least 23 million people in the United States, particularly people of color and underserved populations, significantly worse off than under current law. The ACA and Medicaid are critical sources of health coverage for America’s traditionally underserved communities, which our organizations represent. This includes individuals and families living in poverty, people of color, women, immigrants, LGBTQ individuals, individuals with disabilities, seniors, and individuals with limited English proficiency.

The ACA has reduced the number of people without insurance to historic lows, including a reduction of 39 percent of the lowest income individuals.[i] The gains are particularly noteworthy for Latinos, African Americans, and Native Americans. Asian Americans, Native Hawaiians and Pacific Islanders have seen the largest gains in coverage. The nation and our communities cannot afford to go back to a time when they did not have access to comprehensive, affordable coverage. Further, due to the intersectionality between factors, such as race and disability, or sexual orientation and uninsurance, and issues faced by women of color, many individuals may face additional discrimination and barriers to obtaining coverage. Proposals to replace the ACA with high-risk pools, Health Savings Accounts, or “cheaper” insurance plans that do not offer comprehensive, affordable benefits are unacceptable.

Medicaid is also critically important as it insures one of every five individuals in the United States, including one of every three children and 10 million people with disabilities. Medicaid coverage, including the Medicaid expansion, is particularly critical for underserved individuals and especially people of color, because they are more likely to be living with certain chronic health conditions, such as diabetes, which require ongoing screening and services. People of color represent 58 percent of non-elderly Medicaid enrollees.[ii] According to the Kaiser Family Foundation, African Americans comprise 22 percent of Medicaid enrollment, and Hispanics comprise 25 percent.[iii] They are more likely than White non-Hispanics to lack insurance coverage and are more likely to live in families with low incomes and fall in the Medicaid gap.[iv] As a result, the lack of expansion disproportionately affects these communities, as well as women, who make up the majority of poor uninsured adults in states that did not expand Medicaid. For people of color who experienced some of the largest gains in health coverage, this could mean vastly reduced access to needed health care, increased medical debt, and persistent racial disparities in mortality rates.[v] Further, Medicaid provides home and community-based services enabling people with disabilities to live, work, attend school, and participate in their communities. The proposed cuts would decimate the very services that are cost-effective and keep individuals out of nursing homes and institutions. Finally, one in five people with Medicare rely on Medicaid to cover vital long-term home care and nursing home services, to help afford their Medicare premiums and cost-sharing, and more.

Despite the common myth that all low-income people could enroll in Medicaid, the Medicaid program has only been available to certain categories of individuals (e.g., children, pregnant women, seniors, people with disabilities) and had little to no savings or assets. Parents of children and childless adults were often excluded from Medicaid or only the lowest income individuals in these categories were eligible. For example, the Medicaid expansion greatly expanded coverage for LGBTQ individuals who previously did not fit into a traditional Medicaid eligibility category and for working people struggling in jobs that do not offer health insurance and pay at or near the minimum wage.

The CBO estimated that under the AHCA, as initially proposed, 14 million people would lose their Medicaid coverage by 2026, a reduction of about 17 percent relative to the comparable number under current law.[vi] The AHCA would end the higher federal matching rate for people newly enrolled through the Medicaid expansion and transform the financing from an entitlement program based on the number of persons enrolled to a more limited per capita-based cap or block grant. CBO estimates that by 2026, Medicaid spending would be reduced by $834 billion or 25 percent less than estimated under current law.[vii] This dramatic reduction in funding to the states is likely to result in more people losing coverage and/or needed services, particularly those optional services needed by people with disabilities.

Further, we are very concerned about the possibility of giving states an option under the Medicaid program to impose a work requirement as a condition of eligibility for the first time. Such a requirement not only fails to further the purpose of providing health care but also undermines this objective. Among adults with Medicaid coverage, nearly 8 in 10 live in working families and a majority are working themselves.[viii]

In addition, the AHCA would single out Planned Parenthood and block federal Medicaid funds for care at its health centers. The “defunding” of Planned Parenthood would prevent more than half of its patients from getting affordable preventive care, including birth control, testing and treatment for sexually transmitted diseases, breast and cervical cancer screenings, and well-women exams at Planned Parenthood health centers, often the only care option in their area. This loss of funds will have a disproportionate effect on poor families and people of color who make up 40 percent of Planned Parenthood patients.[ix] Seventy-five percent of Planned Parenthood patients are at or below 150 percent of the federal poverty level and half of their health centers are in rural or underserved areas.[x]

We are seriously concerned about the lack of transparency of the discussions taking place to develop this legislation. After more than seven years and 60 votes to repeal the ACA, there is no excuse for forcing consideration of this bill without adequate time for analysis, hearings, and discussion of a CBO score, providing ample opportunity for the public to understand the proposed legislation and participate in this discussion in which their very access to health care for themselves and their families is at stake.

We urge you to oppose any repeal of the Affordable Care Act, attempts to change Medicaid’s open-ended funding guarantee into a block grant or per capita caps, and any attempts to defund Planned Parenthood. If you have any questions, please feel free to contact Leadership Conference Health Care Task Force Co-chairs Judith Lichtman at the National Partnership for Women & Families ([email protected]), Mara Youdelman at the National Health Law Program ([email protected]), or June Zeitlin at The Leadership Conference ([email protected]).

The League opposes the Senate's plan to repeal the Affordable Care Act as part of a tax overhaul bill. The newest attack on the ACA would cut health care coverage for 13 million people and increase premiums by double digits.